Drug-induced atrial fibrillation/flutter associated with drugs affecting the central nervous system


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Abstract

This review is devoted to the analysis of modern literature on the development of atrial fibrillation (AF) while taking medications that affect the central nervous system. Despite the small amount of published data, clinical cases of drug-induced (DI) AF have been described while taking M-anticholinergic (atropine), antipsychotics (clozapine, olanzapine, paliperidone), anticonvulsant (lacosamide), antidepressants (trazodone, fluoxetine), anti-migraine agents (sumatriptan) and antiemetic agents (ondasterone). The highest incidence of DI AF occurs when prescribing M- and H-cholinomimetics (acetylcholine) - up to 16.6% of cases and taking the antiepileptic drug lacosamide - up to 1.5%. In addition, the analysis showed that opioid use (odds ratio 1.33, 95% C11.11-1.58) was associated with higher AF risks, even after adjusting for other risk factors. In most of these studies, the mechanisms of LI AF have not been elucidated, and the exact frequency and clinical consequences of DI AF remain unclear. Nevertheless, it is important to raise awareness among practitioners of various specialties about the possibility of DI AF while taking drugs that affect the central nervous system, and, if possible, avoid prescribing them, especially in patients with cardiovascular diseases and/or the presence of a paroxysmal form AF.

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About the authors

O. D Ostroumova

Russian Medical Academy of Continuing Professional Education

Moscow, Russia

Marina S. Cherniaeva

Central State Medical Academy of the Administrative Department of the President of the Russian Federation; Hospital for War Veterans № 2

Email: doctor@cherniaeva.ru
Cand. Sci. (Med.), Associate Professor, Department of Internal Medicine and Preventive Medicine Moscow, Russia

O. M Maslennikova

Central State Medical Academy of the Administrative Department of the President of the Russian Federation

Moscow, Russia

O. V Zykova

Hospital for War Veterans № 2

Moscow, Russia

A. G Komarova

Clinical Hospital. S.P. Botkin

Moscow, Russia

D. A Sychev

Russian Medical Academy of Continuing Professional Education

Moscow, Russia

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